Clinical Features of Maintenance Hemodialysis Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China

Abstract

Background and objectivesPrevious reports on the outbreak of coronavirus disease 2019 were on the basis of data from the general population. Our study aimed to investigate the clinical features of patients on maintenance hemodialysis.Design, setting, participants, & measurements In this retrospective, single-center study, we included 49 hospitalized patients on maintenance hemodialysis and 52 hospitalized patients without kidney failure (controls) with confirmed coronavirus disease 2019 at Tongren Hospital of Wuhan University from January 30, 2020 to March 10, 2020. Demographic, clinical, laboratory, and radiologic characteristics and treatment and outcomes data were analyzed. The final date of follow-up was March 19, 2020.ResultsThe median age of 101 patients was 62 years (interquartile range, 49–72). All patients were local residents of Wuhan. In terms of common symptoms, there were differences between patients on hemodialysis and controls (fatigue [59% versus 83%], dry cough [49% versus 71%], and fever [47% versus 90%]). Lymphocyte counts were decreased (0.8×109/L [patients on hemodialysis] versus 0.9×109/L [controls], P=0.02). Comparing patients on hemodialysis with controls, creatine kinase–muscle and brain type, myoglobin, hypersensitive troponin I, B-type natriuretic peptide, and procalcitonin were increased, and the percentage of abnormalities in bilateral lung was higher in computed tomographic scan (82% versus 69%, P=0.15) and unilateral lung was lower (10% versus 27%, P=0.03). Common complications including shock, acute respiratory distress syndrome, arrhythmia, and acute cardiac injury in patients on hemodialysis were significantly higher. Compared with controls, more patients on hemodialysis received noninvasive ventilation (25% versus 6%, P=0.008). As of March 19, 2020, three patients on hemodialysis (6%) were transferred to the intensive care unit and received invasive ventilation. Seven patients on hemodialysis (14%) had died.ConclusionsThe main symptoms of coronavirus disease 2019 pneumonia, including fever and cough, were less common in patients on hemodialysis. Patients on hemodialysis with coronavirus disease 2019 were at higher risk of death.

Outcomes of patients with End Stage Kidney Disease on dialysis with COVID-19. From PCR to Antibody.

“…The overall mortality in our population was 9.2%. Some series have mortality rates of 14-31% in China (14), United Kingdom 19% (15), Turkey 20% (16), Spain 23% (5), Italy 28% (17), and the United States 31% (18). A recent published study from French dialysis units (COVIDIAL) reported mortality of 24%.…”

Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States

“…[18][19][20][21] Single-center and regional studies suggest similarly poor outcomes among individuals with critical 1 2 3 4 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 COVID-19 illness and a pre-existing reduction in kidney function, especially kidney failure treated by maintenance dialysis, but sample sizes were limited and most lacked comparator populations. [20][21][22][23][24][25] Given the rapidly changing landscape of COVID-19 therapeutics and the potential for reduced kidney function to limit therapeutic options (eg, remdesivir), granular broadly representative data characterizing clinical courses of critically ill patients with COVID-19 and pre-existing kidney disease are needed to inform the management of this vulnerable population.…”

COVID-19 in patients undergoing chronic kidney replacement therapy and kidney transplant recipients in Scotland: findings and experience from the Scottish renal registry

“…8 Department of Renal Medicine, Aberdeen Royal Infirmary, Foresterhill Health Campus, Foresterhill Rd, Aberdeen AB25 2ZN, UK. 9 Renal Unit, Raigmore Hospital, Old Perth Road, Inverness IV2 3UJ, UK. 10 Renal Unit, Mountainhall Treatment Centre, Dumfries DG1 4AP, UK.…”

“…There is, however, a lack of data regarding clinical course and outcome in patients receiving KRT following infection with SARS-CoV-2. Furthermore, early reports suggest that case fatality in dialysis patients if infected is high with reports suggesting fatality in the order of 5-20% compared to 1-2% in patients not requiring KRT [9][10][11]. Patients requiring KRT often have multiple comorbid conditions which are widely documented as increasing the risk of death from COVID-19 such as older age, chronic conditions such as diabetes mellitus and hypertension [12,13] but may be at additional risk due to the relatively impaired immune response associated with kidney failure.…”